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Martin-Rodriguez F, Sanz-Garcia A, Lopez-Izquierdo R, Delgado Benito JF, Martínez Fernández FT, Otero de la Torre S, Del Pozo Vegas C. Prehospital Lactate Levels Obtained in the Ambulance and Prediction of 2-Day In-Hospital Mortality in Patients With Traumatic Brain Injury. Neurology 2024; 103:e209692. [PMID: 39088773 DOI: 10.1212/wnl.0000000000209692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To analyze the ability of prehospital lactate levels to predict 2-day in-hospital mortality in patients with traumatic brain injury (TBI), severe TBI (Glasgow Coma Scale (GCS) ≤ 8 points), and mild or moderate TBI (GCS ≥ 9 points). Second, 90-day mortality was also explored. METHODS This was a prospective, multicenter, emergency medical services (EMSs) delivery, ambulance-based, derivation-validation cohort study developed in 5 tertiary hospitals (Spain), from November 1, 2019, to July 31, 2022. Patients were recruited from among all phone requests for emergency assistance among adults who were later evacuated to referral hospitals with acute TBI. The exclusion criteria were minors, pregnancy, trauma patients without TBI, delayed presentations, patients were discharged in situ, participants with cardiac arrest, and unavailability to obtain a blood sample. The primary outcome was all-cause 2-day in-hospital mortality and 90-day mortality in patients with moderate or mild TBI compared with patients with severe TBI. Clinical and analytical parameters (lactate and glucose) were collected. The discriminative power (area under the receiver operating characteristic curve [AUC]) and calibration curve were calculated for 2 geographically separated cohorts. RESULTS A total of 509 patients were ultimately included. The median age was 58 years (interquartile range: 43-75), and 167 patients were female (32.8%). The primary outcome occurred in 9 (2.2%) of 415 patients with moderate or mild TBI and in 42 (44.7%) of 94 patients with severe TBI. The predictive capacity of the lactate concentration was globally validated in our cohort, for which the AUC was 0.874 (95% CI 0.805-0.942) for the validation cohort. The ability of the GCS score to predict lactate concentration was greater in patients with a GCS score ≥9 points, with an AUC of 0.925 (95% CI 0.808-1.000) and a negative predictive value of 99.09 (95% CI 98.55-99.64) in the validation cohort. CONCLUSION Our results show the benefit of using lactate in all patients with TBI, particularly in those with a GCS ≥9 points. Routine incorporation of lactate in the screening of patients with TBI could presumably reduce mortality and deterioration rates because of quicker and better identification of patients at risk.
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Affiliation(s)
- Francisco Martin-Rodriguez
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Ancor Sanz-Garcia
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Raul Lopez-Izquierdo
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Juan F Delgado Benito
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Francisco T Martínez Fernández
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Santiago Otero de la Torre
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
| | - Carlos Del Pozo Vegas
- From the Faculty of Medicine (F.M.-R., R.L.-I., C.D.P.V.), Universidad de Valladolid; Advanced Life Support (F.M.-R., J.F.D.B.), Emergency Medical Services (SACYL); Telemedicine and e-Health Research Group (F.M.-R., R.L.-I., J.F.D.B., F.T.M.F., S.O.T., C.D.P.V.), Valladolid; ; Technological Innovation Applied to Health Research Group (ITAS Group) (A.S.-G.), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina; Evaluación de Cuidados de Salud (ECUSAL) (A.S.-G.), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM); Emergency Department (R.L.-I.), Hospital Universitario Rio Hortega; and Emergency Department, Hospital Clínico Universitario, Valladolid (C.D.P.V.), Spain
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Usategui-Martín R, Zalama-Sánchez D, López-Izquierdo R, Delgado Benito JF, Del Pozo Vegas C, Sánchez Soberón I, Martín-Conty JL, Sanz-García A, Martín-Rodríguez F. Prehospital lactate-glucose interaction in acute life-threatening illnesses: metabolic response and short-term mortality. Eur J Emerg Med 2024; 31:173-180. [PMID: 37988474 DOI: 10.1097/mej.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND IMPORTANCE Lactate is an already recognized biomarker for short-term mortality. However, how glycemia and diabetes affect the predictive ability of lactate needs to be revealed. OBJECTIVE To determine how hypoglycemia, normoglycemia, and hyperglycemia modify the predictive ability of lactate for short-term mortality (3 days). The secondary objective was to evaluate the predictive ability of lactate in diabetic patients. DESIGN, SETTINGS AND PARTICIPANTS Prospective, observational study performed between 26 October 2018 and 31 December 2022. Multicenter, EMS-delivery, ambulance-based study, considering 38 basic life support units and 5 advanced life support units referring to four tertiary care hospitals (Spain). Eligible patients were adults recruited from among all phone requests for emergency assistance who were later evacuated to emergency departments. OUTCOMES MEASURE AND ANALYSIS The primary outcome was in-hospital mortality from any cause within the third day following EMS attendance. The main predictors considered were lactate, blood glucose levels and previous diabetes. MAIN RESULTS A total of 6341 participants fulfilled the inclusion criteria. 68 years (IQR: 51-80); 41.4% were female. The 3-day in-hospital mortality rate was 3.5%. The predictive capacity of lactate for 3-day mortality was only significantly different between normo-glycemia and hyperglycemia. The best predictive result was for normo-glycemia - AUC = 0.897 (95% CI: 0.881-0.913) - then hyperglycemia - AUC = 0.819 (95% CI: 0.770-0.868) and finally, hypoglycemia - AUC = 0.703 (95% CI: 0.422-0.983). The stratification according to diabetes presented no statistically significant difference, and the predictive results were AUC = 0.924 (95% CI: 0.892-0.956), AUC = 0.906 (95% CI: 0.884-0.928), and AUC = 0.872 (95% CI: 0.817-0.927) for nondiabetes, uncomplicated cases, and end-organ damage diabetes, respectively. CONCLUSION Our results demonstrated that glycemia, but not diabetes, alters the predictive ability of lactate. Therefore, hyperglycemia should be considered when interpreting lactate, since this could improve screening to detect cryptic shock conditions.
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Affiliation(s)
| | | | - Raúl López-Izquierdo
- Faculty of Medicine. University of Valladolid
- Emergency Department. Hospital Universitario Rio Hortega, Valladolid
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid
| | | | - Carlos Del Pozo Vegas
- Faculty of Medicine. University of Valladolid
- Emergency Department. Hospital Clínico Universitario
| | | | - José L Martín-Conty
- Faculty of Health Sciences, University of Castilla la Mancha
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla la Mancha
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine. University of Valladolid
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid
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Hagebusch P, Faul P, Ruckes C, Störmann P, Marzi I, Hoffmann R, Schweigkofler U, Gramlich Y. The predictive value of serum lactate to forecast injury severity in trauma-patients increases taking age into account. Eur J Trauma Emerg Surg 2024; 50:635-642. [PMID: 35852548 DOI: 10.1007/s00068-022-02046-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/30/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Two-tier trauma team activation (TTA)-protocols often fail to safely identify severely injured patients. A possible amendment to existing triage scores could be the measurement of serum lactate. The aim of this study was to determine the ability of the combination of serum lactate and age to predict severe injuries (ISS > 15). METHODS We conducted a retrospective cohort study in a single level one trauma center in a 20 months study-period and analyzed every trauma team activation (TTA) due to the mechanism of injury (MOI). Primary endpoint was the correlation between serum lactate (and age) and ISS and mortality. The validity of lactate (LAC) and lactate contingent on age (LAC + AGE) were assessed using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. We used a logistic regression model to predict the probability of an ISS > 15. RESULTS During the study period we included 325 patients, 75 met exclusion criteria. Mean age was 43 years (Min.: 11, Max.: 90, SD: 18.7) with a mean ISS of 8.4 (SD: 8.99). LAC showed a sensitivity of 0.82 with a specificity of 0.62 with an optimal cutoff at 1.72 mmol/l to predict an ISS > 15. The AUC of the ROC for LAC was 0.764 (95% CI: 0.67-0.85). The LAC + AGE model provided a significantly improved predictive value compared to LAC (0.765 vs. 0.828, p < 0.001). CONCLUSIONS The serum lactate concentration is able to predict injury severity. The prognostic value improves significantly taking the patients age into consideration. The combination of serum lactate and age could be a suitable Ad-on to existing two-tier triage protocols to minimize undertriage. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Paul Hagebusch
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany.
| | - Philipp Faul
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Christian Ruckes
- Interdisciplinary Center Clinical Trials (IZKS), University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Uwe Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
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Scriven JW, Battaloglu E. The Effectiveness of Prehospital Subcutaneous Continuous Lactate Monitoring in Adult Trauma: A Systematic Review. Prehosp Disaster Med 2024; 39:78-84. [PMID: 38047359 PMCID: PMC10882558 DOI: 10.1017/s1049023x23006623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/28/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Existing diagnostics for polytrauma patients continue to rely on non-invasive monitoring techniques with limited sensitivity and specificity for critically unwell patients. Lactate is a known diagnostic and prognostic marker used in infection and trauma and has been associated with mortality, need for surgery, and organ dysfunction. Point-of-care (POC) testing allows for the periodic assessment of lactate levels; however, there is an associated expense and equipment burden associated with repeated sampling, with limited feasibility in prehospital care. Subcutaneous lactate monitoring has the potential to provide a dynamic assessment of physiological lactate levels and utilize these trends to guide management and response to given treatments. STUDY OBJECTIVE The aim of this study was to appraise the current literature on dynamic subcutaneous continuous lactate monitoring (SCLM) in adult trauma patients and its use in lactate-guided therapy in the prehospital environment. METHODS The systematic review was conducted in accordance with the PRISMA guidelines and registered with PROSPERO. Searched databases included PubMed, EMBASE via Ovid SP, Cochrane Library, and Web of Science. Databases were searched from inception to March 29, 2022. Relevant manuscripts were further scrutinized for reference citations to interrogate the fullness of the adjacent literature. RESULTS Searches returned 600 studies, including 551 unique manuscripts. Following title and abstract screening, 14 manuscripts met the threshold for full-text sourcing. Subsequent to the scrutiny of all 14 manuscripts, none fully met the specified eligibility criteria. Following careful examination, no article was found to cover the exact area of scientific inquiry due to disparity in technological or environmental characteristics. CONCLUSION Little is known about the utility of dynamic subcutaneous lactate monitoring, and this review highlights a clear gap in current literature. Novel subcutaneous lactate monitors are in development, and the literature describing the prototype experimentation has been summarized. These studies demonstrate device accuracy, which shows a close correlation with venous lactate while providing dynamic readings without significant lag times. Their availability and cost remain barriers to implementation at present. This represents a clear target for future feasibility studies to be conducted into the clinical use of dynamic subcutaneous lactate monitoring in trauma and resuscitation.
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Affiliation(s)
- Jamie W. Scriven
- School of Medicine, Cardiff University, Cardiff, Wales
- West Midlands Central Accident, Resuscitation & Emergency Team, Birmingham, England
| | - Emir Battaloglu
- West Midlands Central Accident, Resuscitation & Emergency Team, Birmingham, England
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
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Enriquez de Salamanca Gambara R, Sanz-García A, Martín-Conty JL, Polonio-López B, Del Pozo Vegas C, Martín-Rodríguez F, López-Izquierdo R. Long-Term Mortality in Patients Transferred by Emergency Medical Services: Prospective Cohort Study. Prehosp Disaster Med 2023; 38:352-359. [PMID: 37272384 DOI: 10.1017/s1049023x23005800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study aimed to determine the long-term mortality (one-year follow-up) associated with patients transferred by Emergency Medical Services (EMS), and to reveal the determinants (causes and risk factors). METHODS This was a multicenter, prospective, observational, controlled, ambulance-based study of adult patients transferred by ambulance to emergency departments (EDs) from October 2019 through July 2021 for any cause. A total of six Advanced Life Support (ALS) units, 38 Basic Life Support (BLS) units, and five hospitals from Spain were included. Physiological, biochemical, demographic, and reasons for transfer variables were collected. A longitudinal analysis was performed to determine the factors associated to long-term mortality (any cause). RESULTS The final cohort included 1,406 patients. The one-year mortality rate was 21.6% (n = 304). Mortality over the first two days reached 5.2% of all the patients; between Day 2 and Day 30, reached 5.3%; and between Day 31 and Day 365, reached 11.1%. Low Glasgow values, elevated lactate levels, elevated blood urea nitrogen (BUN) levels, low oxygen saturation, high respiratory rate, as well as being old and suffering from circulatory diseases and neurological diseases were risk factors for long-term mortality. CONCLUSION The quick identification of patients at risk of long-term worsening could provide an opportunity to customize care through specific follow-up.
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Affiliation(s)
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Griggs JE, Lyon RM, Sherriff M, Barrett JW, Wareham G, Ter Avest E. Predictive clinical utility of pre-hospital point of care lactate for transfusion of blood product in patients with suspected traumatic haemorrhage: derivation of a decision-support tool. Scand J Trauma Resusc Emerg Med 2022; 30:72. [PMID: 36514084 DOI: 10.1186/s13049-022-01061-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Pre-hospital emergency medical teams can transfuse blood products to patients with suspected major traumatic haemorrhage. Common transfusion triggers based on physiological parameters have several disadvantages and are largely unvalidated in guiding pre-hospital transfusion. The addition of pre-hospital lactate (P-LACT) may overcome these challenges. To date, the clinical utility of P-LACT to guide pre-hospital blood transfusion is unclear. METHODS A retrospective analysis of patients with suspected major traumatic haemorrhage attended by Air Ambulance Charity Kent Surrey Sussex (KSS) between 8 July 2017 and 31 December 2019. The primary endpoint was the accuracy of P-LACT to predict the requirement for any in-hospital (continued) transfusion of blood product. RESULTS During the study period, 306 patients with suspected major traumatic haemorrhage were attended by KSS. P-LACT was obtained in 194 patients. In the cohort 103 (34%) patients were declared Code Red. A pre-hospital transfusion was commenced in 124 patients (41%) and in-hospital transfusion was continued in 100 (81%) of these patients, in 24 (19%) patients it was ceased. Predictive probabilities of various lactate cut-off points for requirement of in-hospital transfusion are documented. The highest overall proportion correctly classified patients were found for a P-LACT cut-point of 5.4 mmol/L (76.50% correctly classified). Based on the calculated predictive probabilities, optimal cut-off points were derived for both the exclusion- and inclusion of the need for in-hospital transfusion. A P-LACT < 2.5 mmol/L had a sensitivity of 80.28% and a negative likelihood ratio [LR-] of 0.37 for the prediction of in-hospital transfusion requirement, whereas a P-LACT of 6.0 mmol/L had a specificity of 99.22%, [LR-] = 0.78. CONCLUSION Pre-hospital lactate measurements can be used to predict the need for (continued) in-hospital blood products in addition to current physiological parameters. A simple decision support tool derived in this study can help the clinician interpret pre-hospital lactate results and guide pre-hospital interventions in the major trauma patient.
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Affiliation(s)
- J E Griggs
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK. .,University of Surrey, School of Health Sciences, Priestley Rd, Guildford, GU2 7YH, UK.
| | - R M Lyon
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK.,University of Surrey, School of Health Sciences, Priestley Rd, Guildford, GU2 7YH, UK
| | - M Sherriff
- University of Bristol, Child Dental Health, Bristol Dental School, Faculty of Health Sciences, Lower Maudlin Street, Bristol, BS1 2LY, UK
| | - J W Barrett
- University of Surrey, School of Health Sciences, Priestley Rd, Guildford, GU2 7YH, UK.,South East Coast Ambulance NHS Foundation Trust, Neptune House, Gatwick, Surrey, RH10 9BG, UK
| | - G Wareham
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK
| | - E Ter Avest
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK.,Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Gil B, Lo B, Yang GZ, Anastasova S. Smart implanted access port catheter for therapy intervention with pH and lactate biosensors. Mater Today Bio 2022; 15:100298. [PMID: 35634169 PMCID: PMC9133618 DOI: 10.1016/j.mtbio.2022.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/22/2022] [Accepted: 05/14/2022] [Indexed: 10/29/2022] Open
Abstract
Totally implanted access ports (TIAP) are widely used with oncology patients requiring long term central venous access for the delivery of chemotherapeutic agents, infusions, transfusions, blood sample collection and parenteral nutrition. Such devices offer a significant improvement to the quality of life for patients and reduced complication rates, particularly infection, in contrast to the classical central venous catheters. Nevertheless, infections do occur, with biofilm formation bringing difficulties to the treatment of infection-related complications that can ultimately lead to the explantation of the device. A smart TIAP device that is sensor-enabled to detect infection prior to extensive biofilm formation would reduce the cases for potential device explantation, whereas biomarkers detection within body fluids such as pH or lactate would provide vital information regarding metabolic processes occurring inside the body. In this paper, we propose a novel batteryless and wireless device suitable for the interrogation of such markers in an embodiment model of an TIAP, with miniature biochemical sensing needles. Device readings can be carried out by a smartphone equipped with Near Field Communication (NFC) interface at relative short distances off-body, while providing radiofrequency energy harvesting capability to the TIAP, useful for assessing patient's health and potential port infection on demand.
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Affiliation(s)
- Bruno Gil
- The Hamlyn Centre, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Benny Lo
- The Hamlyn Centre, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Guang-Zhong Yang
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Salzitsa Anastasova
- The Hamlyn Centre, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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Elevated serum lactate levels and age are associated with an increased risk for severe injury in trauma team activation due to trauma mechanism. Eur J Trauma Emerg Surg 2021; 48:2717-2723. [PMID: 34734311 DOI: 10.1007/s00068-021-01811-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The identification of risk factors for severe injury is crucial in trauma triage and trauma team activation (TTA) depends on a sufficient triage. The aim of this study was to determine whether or not elevated serum lactate levels and age are risk factors for severe injury in TTA due to trauma mechanism. METHODS We conducted a retrospective cohort study in a single level one trauma center between September 2019 and May 2021 and analysed every TTA due to trauma mechanism. Primary endpoint of interest was the association of serum lactate as well as age with injury severity assessed by the injury severity score (ISS). RESULTS During the study period, we included 250 patients. Mean age was 43.3 years (Min.: 11, Max.: 90, SD: 18.7) and the initial lactate level was 1.7 mmol/L (SD: 0.95) with a mean ISS of 8.4 (SD: 8.99). The adjusted odds ratio (OR) for age > 65 being associated with an ISS > 16 is 9.7 (p < 0.001; 95% CI 4.01-25.58) and for lactate > 2.2 mmol/L being associated with an ISS > 16 is 6.29 (p < 0.001; 95% CI 2.93-13.48). A lactate level of > 4 mmol/L results in a 36-fold higher risk of severe injury with an ISS > 16 (OR 36.06; 95% CI 4-324.29). CONCLUSION This study identifies age (> 65) and lactate (> 2.2 mmol/L) as independent risk factors for severe injury in a TTA due to trauma mechanism. Existing triage protocols might benefit from congruous amendments.
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Martín-Rodríguez F, López-Izquierdo R, Medina-Lozano E, Ortega Rabbione G, Del Pozo Vegas C, Carbajosa Rodríguez V, Castro Villamor MÁ, Sánchez-Soberon I, Sanz-García A. Accuracy of prehospital point-of-care lactate in early in-hospital mortality. Eur J Clin Invest 2020; 50:e13341. [PMID: 32648960 DOI: 10.1111/eci.13341] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/21/2020] [Accepted: 07/05/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. MATERIALS AND METHODS Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). RESULTS A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut-off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. CONCLUSIONS Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain.,Emergency Medical Services-SACYL, Paseo Hospital Militar, Valladolid, Spain
| | - Raúl López-Izquierdo
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain.,Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Elena Medina-Lozano
- Advanced Clinical Simulation Center, School of Medicine, Valladolid University, Valladolid, Spain
| | - Guillermo Ortega Rabbione
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa (IIS-IP), Madrid, Spain.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), CABA, Argentina
| | | | | | | | | | - Ancor Sanz-García
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa (IIS-IP), Madrid, Spain
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